Despite the ongoing push to increase the number of vaccinated people in the U.S., about 80,000 people will be diagnosed today with Covid-19. Most of them won’t need to be hospitalized. Instead, they will manage their care at home.
Like millions of people over the past two years, they’ll likely be worried that their symptoms could get worse, and may grapple with a decision of if or when to go to the hospital for evidence-based treatment.
At the start of the pandemic, we — and many others working in health systems across the U.S. and around the world — knew that people managing Covid-19 at home would represent the majority of individuals infected with SARS-CoV-2. If a sizable number of them went to hospitals, resources would be strained, in terms of both person hours and physical capacity. A way to support patients at home was desperately needed.
One solution could have relied on conventional approaches, like calling a primary care doctor (for individuals who have one) and being placed in a queue, waiting for a busy provider to call back in between patients. Failing that, some would have had to track down urgent care or after-hours providers, who may have responded hours later.
Another option was to have busy nurses or doctors calling patients once or twice a day to check in. Many patients would not have waited for these check-in calls, and proceeded instead to the nearest — and likely overburdened — urgent care or emergency department. Others feared going to a hospital and may have waited it out at home, putting their lives at risk.
As a way to help people managing Covid-19 at home, we and several colleagues developed and designed Covid Watch — an automated monitoring system that uses text messages to triage individuals before being assessed by a clinician. It asks a simple question twice each day, such as “How are you feeling compared to 12 hours ago?” Individuals who indicate they are doing worse are automatically asked, within a matter of seconds, “Is it harder than usual for you to breathe?” Those who respond “yes” receive a call from a clinician within an hour to assess their health.
The idea was to help people infected by the virus feel safe isolating at home while simultaneously directing those who needed treatment to the nearest hospital — early — so they could receive potentially lifesaving treatments.
This was a relatively new concept. But, as we and colleagues reported Monday in the Annals of Internal Medicine, the use of Covid Watch saved lives during some of the worst stages of the pandemic. Patients enrolled in the program were 68% less likely to die from Covid-19 than those in a control group of people not using the program, likely because they accessed care teams via telemedicine more often and came to the hospital sooner. At peak enrollment, more than 1,000 patients were being cared for by a team of seven or eight nurses total, covering day and night shifts, who responded on average within 24 minutes.
To date, more than 20,000 people have enrolled in Covid Watch — now available in English and Spanish — since it was launched in March 2020.
Although this approach helps care for people with Covid-19, it has greater implications for the future of post-pandemic health care. Automation — using a simple text messaging system backed by a team of clinicians — could efficiently deliver care for large populations while improving their health.
Many industries have already adopted automation — banking, travel, and retail, to name a few — but health care has been slow to adapt. Automating processes can lower costs by allocating high-volume, low-skill tasks that can be standardized to a machine. Automating how we deliver care isn’t something that necessarily replaces doctors, nurses, pharmacists, and other frontline staff, but it can extend their reach. In fact, it can free up health care workers of all skill levels from dealing with routine and mundane tasks and let them focus on those that require human-to-human connections.
While Covid Watch was deployed under the heightened pressures of a pandemic, the health care industry faces incredible challenges moving forward — significant staffing shortages alongside high volumes of patients in hospitals, emergency departments, and outpatient practices. More than ever, health care is under pressure to do more with fewer people.
Patients and providers alike yearn for transformations to how health care is delivered. New approaches are needed to change the status quo — one doctor seeing one patient — and improve the ability to care for whole communities.
How our experience with Covid Watch can be applied to other acute needs like asthma or chronic obstructive pulmonary disease, or more chronic conditions such as diabetes or opioid use disorder, remains to be seen. But we believe that what we built — and the lives it saved — provides direction for how health care should be changing.
Krisda Chaiyachati is a general internist, medical director for Penn Medicine OnDemand, and assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine. M. Kit Delgado is emergency medicine physician, deputy director of the Penn Medicine Nudge Unit, and assistant professor of emergency medicine and epidemiology at the University of Pennsylvania Perelman School of Medicine. Anna U. Morgan is a general internist, medical director of Covid Watch, and assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine.
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